Provider Demographics
NPI:1831112788
Name:JACOBSMA, SANDRA LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:JACOBSMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 COURT ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3243
Mailing Address - Country:US
Mailing Address - Phone:712-293-4700
Mailing Address - Fax:712-293-4805
Practice Address - Street 1:2101 COURT ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3243
Practice Address - Country:US
Practice Address - Phone:712-293-4700
Practice Address - Fax:712-293-4805
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA032041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical